Provider Demographics
NPI:1801078670
Name:BOWEN, CHARLEY WILLIAM JR (MA)
Entity type:Individual
Prefix:
First Name:CHARLEY
Middle Name:WILLIAM
Last Name:BOWEN
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 SYCAMORE RD
Mailing Address - Street 2:
Mailing Address - City:CULLODEN
Mailing Address - State:WV
Mailing Address - Zip Code:25510-9316
Mailing Address - Country:US
Mailing Address - Phone:304-562-7307
Mailing Address - Fax:304-781-6727
Practice Address - Street 1:2400 JOHNSTOWN RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-4738
Practice Address - Country:US
Practice Address - Phone:304-522-7421
Practice Address - Fax:304-781-6727
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV932103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist